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� <br /> CHECK OFF LIST FOR ISSUAI�ICE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: t 5�`1 �=�,Gt R�sC-sS P��� T �� <br /> PID: <br /> DESCRIP'I'ION OF WORK: Aop�T���, s <br /> ZO.�tPli G REV�`V BY: DATE APPROVED: 1�• z�,-6 5 <br /> BUILDI�i i'G REVIE`V BY: ,,,..— DATE APPROVED: /�- z5-os <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _,/ No <br /> PLAN REVIEW Yes _/,� No SE`VER CONiVECTION <br /> STATE SURCHARGE Yes ✓ No `VATERCONNECTION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No _� SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZONI�IG CH�CK LIST Zoning District: L�2- �C. <br /> Fire Department: Post Office: School District: <br /> 13oCa o�w <br /> Lot Area: Sc.ft. Z�, Zi'1 Acres •y$ _ Width i3 S �' 7S' u� Dep[h <br /> � �S� �s' t <br /> Survey Submitted: Yes �_ No Date of Survey: <br /> Proposed Setbacks: W 15� <br /> F�t(Lake): G �b' Right Side: No. i`�' <br /> Rear (Street): /v 1� Left Side: 50• b�� <br /> Adjacent Structures: �I�R �Vedand: �II A <br /> Buildin� Hei�ht: Def. �-igt. U•� Peak Hgt. — <br /> Lot Covera�e: I I°70 <br /> Gradino: Staff Approval Date: �,Ne2 By: — Council Approval Date: _ <br /> Septic: Staff Approval Date: �I�f1 By: <br /> Zoning File: # o�f-9�6 i Resolution: # Resolution Date: 11-e-y <br /> Shoreland District: �e5 <br /> Avg. Setback: o•�� Bluff Setback: /�/✓-� Lot Coverage: ��`(+ <br /> EeistinQ Proposed <br /> �Iardcover: 0-7�' G,r 7•3 G z�• W- `� � � <br /> 7�-250' y 3 s i <br /> 2JO-S00' <br /> 500-1000' <br /> Hardcover Variance Required: Yes �_ tio Da�e oE Council f�.pproval: I t-�b- ��( <br /> ���.�t�i� (gn house�o <br /> 7 <br />